|
|
|
................................ |
Specific Aims This page contains a summary of the project's specific aims: PHASE 1, PHASE 2, and PHASE 3. The objective of the project is to critically examine the feasibility of delivering community-based return-to-work (RTW) programs in rural settings. Completion of this project will provide answers to many questions addressing the feasibility and clinical utility of providing occupational health services in rural settings with companies too small to employ on-site occupational providers. The proposed project (i.e., feasibility study using a clinical trial design) enables the research team to make a transition step from their extensive descriptive work (involving 937 workers with three types of occupational injuries) to a multi-site clinical trial. Phases of project work and respective specific aims include: Phase 1: Finalizing all components of the experimental treatment (month 1-12) There is evidence from occupational health literature that workers in small companies are at higher risk for both injury occurrence and work-related disability, compared with workers in larger companies. To examine risks for delayed recovery in rural workers, existing demographic, treatment, and outcome data from a program of research with injured workers in Oregon will be analyzed (i.e., secondary analysis) to assess differences in the RTW trajectory between workers residing in: 1) rural versus urban areas and 2) smaller (<100 workers) versus larger companies. These data will be used to develop predictive models of RTW for rural workers and small company workers. Findings from this analysis will be combined with clinical data addressing the treatment of acute low-back pain to form the empirical foundation of the experimental treatment (i.e., RTW program). A multidisciplinary panel will be convened to review these analysis and make recommendations regarding specific components of the intervention. Based on committee input, an RTW training will be designed and implemented for participating nurses and other interested providers. Specific aims 1 and 2 will be met during this phase of the project; they include: 1) Finalize components of the RTW program using data from the Oregon studies, and 2) Develop the training protocol and train nurses to provide the intervention in their catchment areas. Back to Top
Phase 2: Feasibility study using a randomized clinical trial design (months 13-48) A feasibility study using a randomized clinical trial design will be conducted during Phase 2. Workers filing claims with the state funds of Montana and Oregon (these contacts have been established) will be randomly assigned to either standard care or the experimental treatment (n=30 subjects, n=30 controls) until a total of 60 workers have been enrolled. Participating workers will be referred to nurses based in Missoula, Montana, Billings, Montana or La Grande, Oregon who will deliver the intervention (four RTW home/worksite visits over a period of four weeks and case management). In addition, all providers involved in the claim will receive information addressing RTW care guidelines for workers (e.g., Agency for Health Care Policy and Research (AHCPR) Guidelines, RTW procedures). Variable measures and instrumentation will be finalized using data from the previous low-back study. Data will be collected from the worker per telephone interview at four designated milestones in the recovery process. In addition, all treatment (e.g., physical therapy) provided during the course of the claim will be quantified from workers’ compensation data extracts. Analyses will focus on comparisons between the two study groups (after adjusting for demographic, treatment, and occupational confounders) on selected outcome variables. Estimates of effect size for power calculations for a full-scale clinical trial will also be obtained. Specific aims 3 and 4 will be met during this period. These aims and corresponding research hypotheses include: 3) Conduct a feasibility study testing the intervention in two communities, and 4) Compare clinical and employment outcomes between the experimental and control groups. Although the small sample size will preclude extensive hypothesis testing, there is evidence (i.e., estimates of effect size from the descriptive study of low-back injuries) from Dr. Butterfield’s research that the following hypotheses can be tested: Hypothesis 1: Satisfaction with care will be greater in the return-to-work versus standard care group. Hypothesis 2: Absenteeism days will be fewer in the return-to-work versus standard care group. Hypothesis 3: Residual symptoms at claim closure will be fewer and of smaller magnitude in the return-to-work versus the standard care group. Back to Top
Phase 3. Feasibility evaluation and development of risk reduction model for rural workers (months 49-60) The final year of the project will encompass a comprehensive assessment of the feasibility of conducting a multi-site clinical trial in the rural West (future research) and the development of an empirically-based risk reduction model for rural workers employed in small companies. Project consultants and the multi-disciplinary panel will be involved in reviewing project data, discussing clinical implications of the findings, and proposing suggestions to improve the quality and scientific integrity of future research in this area. Specific aims 5 and 6 will be achieved during this phase; they include: 5) Evaluate the feasibility of a multi-site clinical trial in rural communities, and 6) Develop an empirically-based model of risk reduction for injured workers in rural communities. Final reports and publications summarizing the clinical, methodological, and feasibility aspects of the project will also be generated during this time. Back to Top |
|
|
